Department of Internal Medicine II-Cardiology, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
Clin Res Cardiol. 2018 Jun;107(6):507-516. doi: 10.1007/s00392-018-1212-8. Epub 2018 Feb 16.
The aim of this study was to adapt patient-specifically a co-registration procedure for image fusion (IF) of a pre-interventional CT dataset with real-time X-ray (XR) fluoroscopy during transfemoral transcatheter aortic valve implantation (TAVI), enabling improved performance of the procedure.
The ability to use 3D models of the respective anatomies to complement the anatomic information obtained by XR fluoroscopy and provide a greater degree of real-time anatomical guidance holds great potential for complex cardiac interventions, especially for TAVI procedures with cerebral protection.
Initial registration of two datasets was performed during the femoral puncture and sheath introduction using routinely acquired arteriographies. On-time refinement of the co-registration was then performed during the on-going procedure avoiding additional angiograms for the co-registration. Performance of the method was evaluated quantitatively in terms of procedural characteristics and clinical events.
Significant reduction of the radiation dose [51 (42-55) vs. 64 (49-81) Gy cm, p = 0.032] and contrast agent (CA) volume [80 (50-95) vs. 100 (80-110) ml, p = 0.010] was achieved with the optimized approach as compared to the control group without IF, with simultaneous decrease of procedural [48 (41-58) vs. 61 (53-67) min, p = 0.002] and fluoroscopy times [14.8 (12.7-18.5) vs. 17.8 (14.3-19.4), p = 0.108].
In this proof-of-concept study we have demonstrated a novel co-registration approach for IF during TAVI not requiring any additional CA or XR scan. We have evaluated its potential benefit with the strong focus on guiding the femoral puncture, placement of the double-filter cerebral embolic protection device, and deployment of the valve prosthesis. We achieved improved performance and safety of the procedure with the introduced approach.
本研究旨在为经股动脉经导管主动脉瓣植入术（TAVI）中术前 CT 数据集与实时 X 射线（XR）透视的图像融合（IF）定制特定患者的配准程序，以提高手术的性能。
使用相应解剖结构的 3D 模型来补充通过 XR 透视获得的解剖信息，并提供更大程度的实时解剖指导，这对复杂心脏介入手术具有巨大潜力，尤其是对于具有脑保护功能的 TAVI 手术。
使用常规采集的血管造影术在股动脉穿刺和鞘管插入期间进行两个数据集的初始配准。然后，在正在进行的手术过程中，避免因配准而额外进行血管造影术，以实现配准的实时调整。通过手术特征和临床事件来评估该方法的性能。
与未进行 IF 的对照组相比，优化方法显著降低了辐射剂量[51（42-55）比 64（49-81）Gy·cm，p=0.032]和对比剂（CA）用量[80（50-95）比 100（80-110）ml，p=0.010]，同时降低了手术时间[48（41-58）比 61（53-67）min，p=0.002]和透视时间[14.8（12.7-18.5）比 17.8（14.3-19.4），p=0.108]。
在本概念验证研究中，我们展示了一种用于 TAVI 术中 IF 的新型配准方法，该方法无需任何额外的 CA 或 XR 扫描。我们以引导股动脉穿刺、放置双滤网脑保护装置和部署瓣膜假体为重点，评估了该方法的潜在益处。我们通过引入的方法实现了手术的性能和安全性的提升。
